Like agents in any other social relationship, patients and physicians will sometimes have difficulty establishing rapport—a physician simply dislikes a patient (or vice versa). Demanding and complaining patients challenge physicians' ability to respond compassionately and to ignore the behaviors that they find offensive. In such situations, it is critical for the physician to make certain that a patient's annoying behaviors which might be chalked-up to "personality" are not actually a reflection of the patient's unmet needs. If the behavior is related to need, the physician has a professional obligation to deal with that need without discriminating against the patient. Hateful, bigoted, and deceptive patients, on the other hand, severely test a physician's objectivity and sense of justice. In these situations, there are no easy remedies, particularly in a medical emergency or when patients' access to other sources of care is limited or non-existent. Restricting the description of a difficult relationship to patients' beliefs and behavior that prevent good care from being dispensed fails to capture the relational complexity of interactions among patient, physician, and context just discussed. Physicians must recognize that difficult clinical encounters come with the territory and that some challenging situations are never going to be adequately addressed.